title: Diminishing surgical site infections after colorectal surgery with surgical care improvement project: is it time to move on?
abstract: BACKGROUND
  Surgical site infections are a major source of expense and morbidity after colon resection.
  
  
  OBJECTIVE
  This study aimed to assess the effect of a targeted intervention to improve compliance with Surgical Care Improvement Project measures on the incidence of surgical site infection.
  
  
  METHODS
  A cohort of patients was prospectively monitored.
  
  
  METHODS
  The investigation was conducted at a university teaching hospital.
  
  
  METHODS
  Consecutive patients underwent open colon resection with anastomosis.
  
  
  METHODS
  A multidisciplinary committee consisting of a surgeon, anesthesiologist, nurses, and quality specialists was convened in late 2004 and a series of initiatives were designed, implemented, and tracked to improve performance on the 4 infection-related components of the Surgical Care Improvement Project program.
  
  
  METHODS
  Compliance with the 4 Surgical Care Improvement Project process measures and the rate of surgical site infection were documented.
  
  
  RESULTS
  There was no improvement in the use of appropriate antibiotics (P = .66), administration within 1 hour of incision (P = .11), cessation within 24 hours (P = .36), or achievement of normothermia (P = .46). Similarly, there was no effect whatsoever on the incidence of surgical site infection over the study period (P = .84).
  
  
  CONCLUSIONS
  The single-institution nature of the study limited its usefulness.
  
  
  CONCLUSIONS
  A 5-year multidisciplinary program of targeted initiatives and interventions failed to improve compliance with Surgical Care Improvement Project measures or to decrease surgical site infection at our institution where colon resections are performed almost exclusively by high-volume specialists. These efforts consumed considerable resources and expenditures, but were of little or no value in our setting.
authors.affiliation: Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Larochelle
authors.forename: Neil
authors.initials: N
authors.lastname: Hyman
authors.forename: Linda
authors.initials: L
authors.lastname: Gruppi
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D003107:Colorectal Surgery / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014707:Vermont / Q000453:epidemiology